- Highmark Health (Tallahassee, FL)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... data-driven insights from complex healthcare datasets (eg, claims, clinical, utilization , pharmaceutical) to inform policy development, identify areas for… more
- Elevance Health (FL)
- …Qualifications:** + Internal Medicine, or Family Medicine specialties preferred. + Utilization Management or Appeals experience preferred. For candidates working ... must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military… more
- Community Based Care of Brevard, Inc. (Orlando, FL)
- …and a web-based application for daily entry of case activity and the utilization management of service authorizations. 2+ years of Team Facilitation Skills ... to maximize resources and adhere to policies and procedures. Responsible for utilization and monitoring flexible funding and service coordination in order to meet… more
- Highmark Health (Tallahassee, FL)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- Veterans Affairs, Veterans Health Administration (Gainesville, FL)
- …tools to monitor the success of those efforts. Work with the VA Utilization Management (UM) department staff to monitor the preadmission screening process ... its success in impacting InterQual appropriate inpatient admission/observation status utilization performance measures. Monitoring overall performance of all providers… more
- Prime Therapeutics (Tallahassee, FL)
- …and timely fashion. + Demonstrates the value of pharmacy solutions (unit cost, utilization management & patient care enhancement). + Identifies opportunities for ... cost solutions that meet the desired outcomes of the customer; general management of the account, including P&L responsibility; and accountability for contract… more
- ERP International (Macdill AFB, FL)
- …algorithms, CM software, and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case management with ... International is seeking **Registered** **Nurse (RN)** for Full-Time positions in **Case Management ** at MacDill AFB, FL. Apply online today and discover more about… more
- ERP International (Hurlburt Field, FL)
- …algorithms, CM software, and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case management with ... sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states.… more
- Molina Healthcare (Jacksonville, FL)
- …physicians. Such meetings would occur to discuss and resolve issues related to utilization management , pharmacy, quality of care, and correct coding, for ... position is February.** **Job Summary** Molina Health Plan Provider Network Management and Operations jobs are responsible for network development, network adequacy… more
- Select Medical (Miami, FL)
- …allotted time frame; assuring payments of hospital-based services meeting patient-related utilization management criteria, and implementation of safe and ... of the discharge planning process. + The primary job functions in Case Management include: + Clinical Interventions/Discharge Planning + Care Planning Management … more